Letters to the editor

Amebic perforation of the colon: rare and frequently fatal complication

Amebic colitis perforation is a rare clinical form of amebiasis characteristically associated with high morbidity and mortality. We here present our series of eight patients with amebic colitis perforation. These patients represent 5% of 150 patients hospitalized during the same period for chronic amebic colitis. Only 50% of our patients had a correct preoperative diagnosis, and signs of generalized peritonitis such as rebound tenderness or muscular rigidity were not as common as might have been expected. Our mortality rate was 50% despite aggressive surgical treatment. Every effort should be made to have an early diagnosis, which would lead to early treatment with antiamebic agents, earlier and more limited surgery, and improved survival of these patients.

Role of intraoperative prograde colonic lavage and a decompressive loop ileostomy in the management of transmural amoebic colitis

A prospective analysis is presented of a selected group of 45 consecutive patients with transmural amoebic colitis treated by laparotomy, colonic lavage and ileostomy (phase 1 surgery) over 3 years. The diagnosis of amoebic colitis and amoebic perforation of the bowel were difficult and therefore all patients with 'acute abdomen' had proctosigmoidoscopy and a trial of metronidazole for 24-48 h before laparotomy. At laparotomy, adhesive wraps were present in all patients; 13 perforations were exposed by inadvertent disturbance of adhesive wraps but were successfully closed by suture to any available organ in close proximity, such as the omentum or small bowel. Four patients (9 per cent) died after phase 1 surgery. After 6 weeks when the acute disease had healed, 33 of the remaining 41 patients (80 per cent) required closure of ileostomy only, five had resection of stricture and three (7 per cent) needed stricturoplasty (phase 2 surgery). Two patients (5 per cent) died after phase 2 surgery. Thus, in surgery for transmural amoebic colitis adhesive wraps should not be disturbed as they mechanically protect the peritoneal cavity from faecal soiling when perforation occurs. The colon should be emptied by lavage and the faecal stream diverted to avoid secondary bacterial effects.